What Is Lymphoma, and Is It Serious?

A Guide to Navigating Lymphatic Cancer

Medically reviewed by Doru Paul, MDMedically reviewed by Doru Paul, MD

Lymphoma is a type of blood cancer originating from lymphocytes, a type of white blood cell that is part of the immune system. Like all cancers, lymphoma is a serious condition that requires treatment. The most common forms of this disease are Hodgkin and non-Hodgkin lymphoma.

An early symptom of lymphoma is lumps or swelling in the lymph nodes of the neck, armpits, and collarbone. These lumps may be painless, but in some instances, they may cause pain or pressure in the back, chest, and abdomen.

It's not possible to know you have lymphoma based on symptoms alone. It's also possible to have lymphoma and not be aware of it until additional symptoms occur.

This article will describe the symptoms and treatment options for Hodgkin and non-Hodgkin lymphoma and discuss prognosis, remission, and survival rates.

Lymphoma: Getting a Diagnosis and What It Means

Lymphoma symptoms can go unnoticed for a long time. In some instances, lymphoma may first be suspected during a routine physical exam. It may also be discovered when you seek medical attention for an unrelated condition or symptoms common to muscle strain, infections, or other conditions.

Getting this diagnosis can come as an unpleasant surprise. If you're diagnosed with lymphoma, it means you will require treatment, which is based on the type of lymphoma and the stage it's in.

Diagnostic tests for this condition may include:

• Blood tests that check for abnormal blood cells, blood cell counts, and other indicators

• Physical exam to check for swollen lymph nodes and enlargement of the liver or spleen

• Imaging tests

• Lymph node biopsy: Removal of a lymph node to examine in the lab

• Bone marrow biopsy: Sampling of bone marrow to be analyzed in the lab

These tests will be used to confirm the diagnosis and determine the type and stage of lymphoma.

Hodgkin Lymphoma

Hodgkin lymphoma is most common in males. The age of onset is most likely to occur either in early adulthood (20 to 39) or late adulthood (65 and over). However, people of any age or sex can get this diagnosis. A prior Epstein-Barr virus infection increases your risk for this condition.

The two main forms of Hodgkin lymphoma are classic and nodular lymphocyte-predominant.

Classic Hodgkin lymphoma presents with large, abnormal white blood cells, called Reed-Sternberg cells, under a microscope. These cells increase in number as the disease progresses. Classic Hodgkin lymphoma is curable, especially when diagnosed early. Classic Hodgkin lymphoma has four subtypes.

Nodular lymphocyte-predominant Hodgkin lymphoma is a slow-growing, rare form of this disease. It is earmarked by lymphocyte-predominant cells, sometimes referred to as popcorn cells, which are different from Reed-Sternberg cells. This form of Hodgkin lymphoma is not considered curable, but periods of remission prior to recurrence are common.

A Note on Gender and Sex Terminology

Verywell Health acknowledges that sex and gender are related concepts, but they are not the same. To accurately reflect our sources, this article uses terms like “female,” “male,” “woman,” and “man” as the sources use them.

Non-Hodgkin Lymphoma

Non-Hodgkin lymphoma becomes more common as people age. Like Hodgkin lymphoma, a prior Epstein-Barr virus infection increases your risk. So does having an autoimmune condition or taking medications that cause immunosuppression. Males are at greater risk than females.

Non-Hodgkin lymphoma can be indolent (slow-growing) or aggressive. Each type of disease has multiple variations. The type you have and its stage determines potential curability.

Indolent Non-Hodgkin Lymphoma

Follicular lymphoma is the most common form of indolent non-Hodgkin lymphoma. This form of the disease may resolve or go into remission without treatment. However, this condition is not considered curable. A recurrence of follicular lymphoma is possible after remission.

People with follicular lymphoma make abnormal B lymphocytes. Scans and a lymph node biopsy are needed to diagnose this condition.

Aggressive Non-Hodgkin Lymphoma

Diffuse large B-cell lymphoma is the most common form of aggressive non-Hodgkin lymphoma. Although it is aggressive, diffuse large B-cell lymphoma is considered curable. This form may originate within the lymphatic system or in any organ of the body.

Diffuse large B-cell lymphoma is further broken down into subtypes. Each subtype produces cells that present differently under a microscope. T-cell/histiocyte-rich B-cell lymphoma, a common subtype, produces large, atypical B cells, which will appear in a scattered formation.

Early Lymphoma Symptoms

Lymphoma symptoms vary based on the type of lymphoma you have. Signs and symptoms of this disease also vary between people.

Swollen lymph nodes are the most common early symptom of lymphoma. These swollen areas feel like lumps. You may notice them in any area of the body, but they are most commonly discovered in the neck, armpits, collarbone, or groin.

Other early signs and symptoms of lymphoma may include:

• Back or chest pain (caused by pressure from a swollen lymph node)

• Coughing or a feeling of breathlessness (caused by swelling within the chest)

• Bone pain

• Extreme fatigue

• Abdominal pain or swelling

• Itchy skin: Caused by the release of cytokines (chemical messengers involved in inflammation and other processes) from the immune system

• Skin rash

• Unusual bleeding

• Bruising easily

• Frequent or hard-to-treat infections

Progressive Symptoms

As lymphoma progresses, people may experience a group of symptoms referred to as B symptoms. They include:

• Night sweats

• High fever

• Weight loss

When to Consider Diagnostic Testing

You can't self-diagnose lymphoma. You cannot know if you have it based on physical symptoms alone, as the symptoms can be due to many other disease processes. See a healthcare provider if you experience swelling or pain or don't feel well for weeks.

Your healthcare provider will do a thorough physical exam to look for swollen areas. They will ask about your family history of this and other diseases. They will also ask about your history of infections and current diagnoses you may have.

Testing will be done that either confirm or rule out lymphoma. A lymph node biopsy is the only way to determine if you have lymphoma and, if so, what type. Imaging tests determine if cancer has spread to other parts of the body. These tests are essential for selecting the best kind of treatment.

Causes of Lymphoma Tumors

The underlying cause of lymphoma is not always clear-cut. Male sex and aging are risk factors. So is having a weakened immune system, a family history of this disease, or a personal history of certain viruses and conditions, including Epstein-Barr and HIV.

Lymphoma Treatment Options

The type of lymphoma you have, as well as the stage of the cancer, will determine the treatments that are recommended. Your overall health and age, as well as your personal preferences for treatment, will also be considered.

Hodgkin Lymphoma Treatment

The goal of Hodgkin lymphoma treatment is to cure it. The most commonly used treatments for this disease are chemotherapy and radiation. Your cancer team may recommend one or both treatments for you.

In instances where chemo and radiation do not produce optimum results, other treatments may be recommended, such as immunotherapy, or high-dose chemotherapy, coupled with a stem cell transplant.

Immunotherapy for Hodgkin lymphoma uses medicines that help the immune system identify and destroy cancer cells. Monoclonal antibodies are often used. These are highly specific immune system proteins produced in quantity artificially.

Stem cell transplants, also known as bone marrow transplants, replace damaged bone marrow cells with healthy stem cells after high-dose radiation is given.

Non-Hodgkin Lymphoma Treatment

Non-Hodgkin lymphoma treatments vary based on the type and stage of cancer you have.

Chemotherapy is the main treatment used for this disease. It may be used alone or with radiation therapy or immunotherapy drugs. As is the case with Hodgkin lymphoma, high-dose chemo plus stem cell transplants may also be used.

If standard chemotherapy is not helpful, targeted drug therapy may also be tried. This treatment uses medications that interfere with or halt the actions of certain proteins, enzymes, or cancer cells. Velcade (bortezomib) is a proteasome inhibitor sometimes used for non-Hodgkin lymphoma.

Chimeric antigen receptor (CAR) T-cell therapy is used for some types of non-Hodgkin lymphoma. In this type of therapy, the person's T-cells (a type of immune cell) are harvested and modified in the lab to have receptors that will attach to lymphoma cells. They are induced to multiply and then infused back into the person to attack the lymphoma cells.

If your cancer originated in your spleen or organs outside of the lymphatic system, surgery may be recommended as a treatment.

Prognosis and Survival Rates for Hodgkin and Non-Hodgkin Lymphoma

Survival rates are ballpark numbers that reflect upon the experience of people who had cancer at least five years ago. Treatments continue to improve, and clinical trials are typically available for many forms of lymphoma. These innovations yield ever-increasing chances for survival through new and effective treatments and cures.

The stage of your cancer's progression will impact your potential prognosis. If you have non-Hodgkin lymphoma and cancer has spread to more than one organ outside the lymphatic system, your prognosis may be less optimistic. Age also plays a role. People over 60 may have poorer outcomes with this type of cancer.

The relative five-year survival rates for non-Hodgkin lymphoma are:

Diffuse large B-cell lymphoma:

• Localized - 73%

• Regional - 74%

• Distant - 58%

Follicular lymphoma:

• Localized - 97%

• Regional - 91%

• Distant - 87%

If you have Hodgkin lymphoma, the presence of B symptoms may indicate a less optimistic prognosis. People over 45 may also be more likely to have a less favorable outcome.

The relative five-year survival rates for Hodgkin lymphoma are:

• Localized - 93%

• Regional - 95%

• Distant - 83%
  

Lymphoma Resources for Patients and Their Families

Many organizations and hospitals offer support groups and other types of care for people with lymphoma.

• The American Cancer Society provides information and support via video chat on weekdays from 7:00 a.m. to 6:30 p.m. Central time. You can schedule a video chat online or call them at 800-227-2345.

• The Leukemia and Lymphoma Society holds in-person support groups, including peer-to-peer support, for patients and their families.

• Peer-to-peer support is also available through the Lymphoma Support Network.

• CancerCare provides counseling, financial support resources, and support groups.
  

Summary

Lymphoma is a type of blood cancer that impacts the lymphatic system, immune system, and other parts of the body. The most common types are Hodgkin and non-Hodgkin lymphoma.

Swollen lymph nodes are a common first symptom of lymphoma. However, the symptoms may be due to many other diseases, so lymphoma must be diagnosed by a healthcare provider. The diagnostic process involves a physical exam, blood work, lymph node biopsy, and imaging.

Treatment can include chemotherapy, radiation, immunotherapy, and a stem cell transplant, depending on the type and stage of lymphoma. Some types can be cured.

Your prognosis and potential survival rate for lymphoma will be impacted by the type you have and the stage it is in. Your oncology team will work with you to determine the treatments that can give you the best possible outcome.

Read the original article on Verywell Health.